136608094-2-3-2022-20-CC-CGRY-CBK367-20220211165748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 136608094
Report Date: 02/03/2022
Date Signed: 02/03/2022 02:13:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Dana Stevens

PUBLIC

COMPLAINT CONTROL NUMBER: 20-CC-20211116093315

FACILITY NAME:	ICOE-ECEP BRAWLEY HAWKS HEAD START CENTER		FACILITY NUMBER:	136608094
ADMINISTRATOR:	ANDREA JIMENEZ		FACILITY TYPE:	850
ADDRESS:	160 SOUTH CESAR CHAVEZ STREET		TELEPHONE:	(760) 351-8577
CITY:	BRAWLEY	STATE: CA	ZIP CODE:	92227
CAPACITY:	55	CENSUS: 12	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Elisa Vera		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Lack of supervision which resulted in injury to a child
Failure to report child's injury to authorized representative

INVESTIGATION FINDINGS:

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On 02/03/2022 at 12:00 PM, Licensing Program Analyst (LPA) Dana Stevens conducted an unannounced complaint inspection for the purpose of delivering findings on the above allegations. LPA met with Site Supervisor Elisa Vera and toured the inside and outside of the facility. There were 12 children present with 3 staff. Facility was found in compliance with capacity and ratio requirements.

Department received information alleging Lack of Supervision which resulted in injury to a child. On 10/05/2021 Child 1(C1) fell while climbing on playground playstructure resulting in a fractured arm. There were 15 children and 3 staff present on the playground at the time of the the incident. Staff stated parent of C(1) was notified of the incident immediately by phone. The incident was reported by Center Administrators to Child Care Licensing Department (CCLD) Duty Officer on 10/05/2021 and a written report was received by CCLD on 10/07/2021.

On 11/10/2021, C1 fell down while playing on the playground and re-injured the right arm. There were 16 children and 3 staff present on the playground at the time of this incident.Staff stated that parents were notified of the fall the same day when C(1) was picked up from school. A written report of the incident was recieved by CCLD on 11/16/2021. During the investigation interviews were conducted with center staff, daycare parents and daycare children. LPA reviewed facility records and medical documentation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 20-CC-20211116093315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ICOE-ECEP BRAWLEY HAWKS HEAD START CENTER	FACILITY NUMBER: 136608094
	VISIT DATE: 02/03/2022

NARRATIVE

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Based on conflicting information obtained in confidential interviews and review of facility records, there is not a preponderance of evidence to support the allegations Lack of Supervision which resulted in injury to a child and Failure to report child's injury to authorized representative, thus these allegations are deemed Unsubstantiated.

Exit interview was conducted and copy of this report and appeal rights were left with site supervisor. Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

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